LONDON – After a second day of deliberation, the World Health Organization (WHO) held off declaring that the novel coronavirus infection raging in Wuhan is an international health emergency, saying the low number of cases outside China means it is not time to escalate the response to this level.

That is despite the fact that WHO’s Emergency Committee was divided almost 50-50 and that since the committee convened on Jan. 22 the number of cases reported to WHO increased from 460 to 584, and the number of deaths rose from nine to 17.

“It was a complex deliberation,” said Tedros Adhanom Ghebreyesus, director general of WHO. “Make no mistake, though, this is an emergency in China. But it has not yet become a public health emergency of international concern. It may yet become one.”

There is a high risk in China, regionally and globally, Ghebreyesus said. WHO is coordinating a network of partners working on the development of diagnostics, vaccines and therapies and he is prepared to recall the Emergency Committee at any time to reconsider the position.

Didier Houssin, of France’s National Agency for Health Security, Food, Environment and Work, who is chair of the Emergency Committee, said members who had divided opinions “continued today to be in the same position.”

Several members of the committee “were reinforced in their views, considering the evolution of the epidemic, the increased number of cases and the severity of disease,” Houssin said. “Several others said it is too early because of the limited number of cases abroad.”

A further factor was the effort being made by Chinese authorities to limit the spread. “The perception [of calling an international emergency] in the country most affected has to be considered,” said Houssin.

It also is the case that WHO can put out advice without declaring an international public health emergency, and the signs to date are that member states are responding to WHO’s recommendations.

To help fill the gaps in understanding about 2019-nCoV, the novel coronavirus causing the infection, the Emergency Committee wants to set up multidisciplinary international team to investigate questions such as where the virus originated and how it is transmitted.

Houssin also called on China to “pursue the policy of transparency and to provide explanations of risk management,” to ensure it is understood what control measures are in place, and why.

From 10 a.m. local time on Jan 23, Wuhan, the city of 11 million people that is the epicenter of the outbreak, has been quarantined, with no one allowed to leave the city. There also are health screens at railway stations and airports elsewhere in China.

Houssin said China should reinforce risk management measures, with a special focus on exit screening.

The advice for the U.S., Japan, Singapore, Vietnam, Korea, Macau, Taiwan and Thailand, where there are confirmed cases of 2019-nCoV infection, and for other WHO member states is “to be ready to cope with these and any other cases, to avoid extension of the epidemic,” Houssin said. Suspected cases in other countries are being assessed.

“I finally want to tell the international community it may be necessary to call a public health emergency of international concern in time,” said Houssin. “The Emergency Committee will reconvene as soon as necessary.”

What we know

“This virus causes severe disease and it can kill,” Ghebreyesus said. However, the majority of cases are mild and those that have died had underlying health problems such as diabetes and cardiovascular disease, which weakened their immune systems.

There is human-to-human transmission, but for now that has been limited to family groups and health care workers in close proximity to infected individuals. “There is no evidence of human-to-human transmission outside China,” said Ghebreyesus.

There are still a lot of unknowns, including the original source, how quickly the virus spreads and what the clinical features are. “WHO is working night and day with China and [other] affected countries to fill the gaps in our knowledge as soon as possible,” Ghebreyesus said.

Ghebreyesus thanked the Chinese government for its transparency and the speed with which the virus was isolated and sequenced. “It was caught because a system was put in place to monitor severe lower respiratory disease,” he said.

“We are at a critical phase in this outbreak,” said Peter Piot, professor of global health and director, London School of Hygiene & Tropical Medicine, who discovered the Ebola virus in 1976 and led efforts to control the first Ebola epidemic that same year. “Regardless of the decision not to declare this a public health emergency of international concern, intensified international collaboration and more resources will be crucial to stopping this outbreak in its tracks.”

Piot said there are still many gaps in understanding this new virus, which is spreading rapidly across China, and “most probably” around the world. “Over the coming days and weeks we will know much more, but there cannot be any complacency as to the need for global action,” he said.

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